Jackonicko

I believe your post of 14 Oct at 15:19 hits the nail on the head. I think the complexity of this HEMS stuff needs to be scaled back or we all go to two-pilot, NVG, IFR, etc.

Unfortunately Gomer probably has it right when he mentions none of this is going to happen in our lifetime - but I believe weather standards may continue to go up.

WIII

There are a whole host of things that come with twin engine helicopters, if they are treated as such properly. More than 5 hours of training is needed to come to grips with the complexities of single engine failures, especially if Category A procedures are included. AFCS operation also takes quite a bit of getting used to, and the AFCS and autopilot need to be used all the time, not just as a crutch when things aren't going well. More than 5 hours of training for someone new to a complex multi-engine helicopter is definitely needed.
A good case can be made that the relatively small number of takeoffs at scenes compared to total takeoffs would allow Category A performance to be waived for scene takeoffs, or at least some other guidance given on how to best use the OEI capability if needed. (Sorry but this isn't well stated- the caffeine hasn't kicked in yet this morning).

Have been following with interest the discussion around the EMS in the US in this thread, my opinion is the following:

- It´s very very tragic will all this resent EMS accidents and everything possible should be done to stop this negative trend (i.e. immediate and long term actions)
- the goal in any (EMS) flight operation have to be that, one single fatal accident is unacceptable

After having being involved in the HEMS in Europe I somehow have come up to the following:

- In Europe the HEMS flight operations is very “regulation/authority driven”
- In the US the EMS flight operations seems to be very “market driven”

I have many times been thinking that a system that should be somewhere between the US and European system could be a perfect solution (also when considering the long terms effects). On one hand one accident is too much but on the other hand someone has to pay for every flight in one form or another (free competition or government founded).

I think that the solution for safer EMS operations in the US consists of many factors that are involving some rather tuff and hard changes, ranging from customers to management to pilots to equipment (if the solution would have been very simple it should have been made a long time ago already J). Without knowing to much accurate details about the US EMS operations I have noticed the following:

• Flying VFR at night unaided in areas with very little or no visual references, should have in my opinion minimas like, Cloud base 2500-3000 feet and visibility of at least 10 km (yes, I know that with these minimas you will have to cancel a lot of missions during night time). The minimas could be slightly lower if you operate over cities and highly populated areas with a lot of illuminated ground references or if you have NVG.
• Before going on a night mission you should have the time to spend some 5 minutes extra on getting accurate weather information and talking to a meteorologist. Getting some accurate weather information over the region you are operating in.i.e. how fronts are moving and when they are expected to move in etc. A very good briefing and understanding of the weather in a big enough area is important. You might get a new mission during the flight with a higher priority or at the accident site you might get the destination hospital and to be able to make a go/no-go decision you must have good accurate weather information.
• If I had understood right, the systems in the US works so that the first EMS helicopter on accident site will get the job. With this time pressure 1 minute could be the difference of getting the job or not. In general in HEMS it will very seldom makes a difference in helping a patient if you come 5 minutes earlier or later (it can sometimes, but very seldom). Very often there is already ground units on the accidents sites before a helicopter reach it. In this terms there should be the required time to get accurate weather etc. information before making go/no-go decision. If you are competing with other EMS helicopters to be first on the accident site it looks like you have no time to make a good go/no-go decision based on accurate facts.
• Have Standard operating procedures (SOP) for the operations. They should not be written with the intention of satisfying any inspector from the Authorities. They should be written for the pilots and should be as simple and clear as possible. They should be practised in simulator at least twice a year representing scenarios in the operational area.

As I said earlier, these are only my opinions!


Cheers,

Vertolot

Vertalot, a couple of corrections. It's not the first helicopter on the scene. In theory, the nearest helicopter should be called, but often it depends on the whim of the local EMS dispatcher or crew. I've never heard of multiple helicopters launching on their own, like wrecker trucks.

Talking to a meteorologist and getting accurate weather information isn't an option. The flight service station system has been privatized, and the last time I called for weather information, the briefer was in Minnesota, a couple of thousand miles away, and had no more information than I could get from reading the METARs. It's not possible to talk to an actual meteorologist, just someone in a windowless room miles away who just reads the data on his computer screen. With METAR stations as much as a hundred miles apart, the only way to get accurate weather information is to go look at it. That's the result of privatization and using the lowest bidder, or more often now, no bidder at all, just whomever has made the largest 'campaign contributions'.

Gomer Pylot,

Thanks for the corrections!

/Vertolot

When will the madness end?
 

Another EMS accident in Missouri claims 4 more lives

4 dead in helicopter crash - Local News Story - St. Joseph

I share your sentiments. This just has to stop,

1)When EMS operators start following the IHST toolkits on SMS, training and maintenance
2) When they invest in modern twin helicopters, certified to the latest standards (including crashworthiness)
3) When they operate with two crew
:p
Four die in Clay County medical helicopter crash - KansasCity.com


Mechanical problem documented in chopper that matches partial tail number and markings at crash site- NBCActionNews.com

SM, if the preliminary reports on this accident turn out to be true, the cause may have been something that NONE of your three items would have prevented. But I'm sure your sanctimonious attitude helps you sleep better at night.

Ah well; Shell Management, just like the real Shell claims to know all and is often found wanting. He/she can rarely provide proof of his claims and is so often wide of the mark that his/her pilot hatred is all that is obvious.

SM; you were the subject of a conversation in our office the other day, three management pilots, five line pilots, 4 members of the CAA and a member of EASA, a quality manager and a head of engineering all of whom have worked on Shell contracts were discussing what a total t***er you are.
And the more evangelical you become the more ridiculous you make yourself.

Why not wait for the accident report before telling us where aviation is going wrong?

In this case your comments are ill-timed and crass. Doubtless you see yourself as a saviour, I don't. So spare us your opinions and go take a good hard look at the real Shell. Maybe they will listen to you, because let's face it no-one one here takes you seriously.

VH

Rather unnecessary I think. :ugh:

Like him or not - personal feelings should not be relevant. I don't think I can disagree with the points SM makes about safety, and his suggestions are certainly very valid.

Agree with Horror Box, SM does make valid points that seem to be the root cause of most EMS accidents in the US.

The reason I started the thread is I recently read Randy Mains' book "The Golden Hour" which was written in the early 80's and outlines the same problems that EMS pilots still face today. It dumbfounds me that in 30 years the industry has learned nothing, while the Canadians and Europeans manage to do it safely.

Unfortunately, I don't think anything will change until profit margins are taken out of the equation and all programs are government contracts or charity based........some how I don't see that happening in the good old USA

vh - you can be rude about people if you like but I'm afraid that, whether you like his comments, attitude or the individual, or not, there is no doubt that if the measures mentioned by SM were taken, the already risky business of EMS flying, which is multiplied many-fold by doing so at night, with one engine and invariably no autopilot, would be significantly reduced. IMHO, whilst SM item 3 (two crew) is great if you can afford it, items 1 & 2 would be a good place to start - SPIFR, with the proper equipment, is significantly preferable, and less risky, than more holes in the ground. :ugh:

What might have been a lifeline for one, in this case, turned out to be a death-line for four. It's not the first time nor, sadly, is it likely to be the last, until someone takes responsibility and legislates some significant risk-reduction measures. Flying cheaper aircraft to make a quick buck is not the way to go, IMHO, & I dread to think what EMS aircraft & crew insurance premiums are like in the USA, although I suspect they're subsidised by all that medical insurance that pays so much for the flights in the first place? :suspect:

VH
 

Sad when people take all the trouble to burst into print when their sole aim is to shoot the messenger.

It's probably been said before but this site would benefit if people stuck to making their point and avoided personal abuse or pointless mud-slinging.

G. :sad:

I hate to say this, but the "maintenance" article that SM is referring to in his post is total crap.
I am quoting from the article:"The guide vane sends gas from the compressor onto the blades and makes the rotors turn.:rolleyes:

That sentence alone shows total ignorance of subject.

Yes, we all know the sad situation governing the US EMS industry, yes it is sad that four persons perished, but SM has been correct before and while his post jumps to conclusions a bit prematurely, personal attacks are not entirely justified nor appropriate.

I have found the best way to accomodate SM is by use of the Ignore feature....as that prevents any aggravation while getting through his posts to anything substantive.....basically....if one does not see it...one does not get tempted to read it.

so to para-phrase an old strapline.......
"you can (or maybe not) be sure of Shell"
;)

VH and Sas,

I would never ignore your posts as they are so entertaining because of gross ignorance. I do not know who SM is, or care, but the safety initiatives Shell has supported are beneficial to the industry.

The Sultan

SM, why you would undermine valid points with the use of the ridiculous tongue-stuck-out symbol is beyond me. In the context it really is innappropriate.

Get a grip fella.

The Sultan
I agree posts by SASless are often entertaining. :ok:

Gross ignorance?
You'll have to make allowance for his inexperience. He's only got 10,000 hours, 2000 Army instructing, two Chinook combat tours in Vietnam, four years flying Hueys in the National Guard and 30+ years experience flying a variety of onshore/offshore ops in various parts of the world.

--------

Personal feelings should not be relevant and personal attacks are not acceptable but Shell Management has only himself to blame for his general lack of credibility. Various PPRuNe forums are littered with sweeping assertions by SM on a very wide range of topics which he is unable to back up when challenged.
That doesn't mean he's incapable of making a good point occasionally but it might explain why people react as they often do, in this and other forums.


H.

Can't offer an opinion on this
No matter how many eninges you put in the bird, it only has one transmission, and the bulk of accidents do not come from engine failure
The most sensible and valid point as most accidents are human factors related.

You could safe a ton of money flying singles and using that for a second set of eyes and ears.....

Far more valuable to me than a second engine, and a higher probability of keeping one from an incident.

Many would feel comforted to know SM sleeps so well at night. :eek:



Revealed: Shell

Just some thoughts from a study into the challenges faced by China which is about to rapidly expand the nation’s SAR and HEMS capability. In reality, the country is raising the equivalent of a small air force from almost nothing. (US 12,000 helicopters – China 127).

Their last fatal - an AW139, 17 Aug '11 four dead, believed to be a training flight, is now being investigated. Our thoughts are with their families, etc.

As history shows this can be a very costly business. Statistical evidence from the World Wars, Korea, Vietnam and later conflicts show that rapid expansion can result in enormous losses. This is usually caused poor supervision and training coupled with inexperience.

So what is the implication for China? Where do we start our research? What are the implications for the safety of aeromedical flight crewmembers?

It is estimated by the Association of Air Medical Services (USA), helicopters transport 400,000 patients annually in the United States. The growth in the HEMS industry has been spectacular. From 1995 to 2008 the number of helicopters used in aeromedical services increased by 130%.

Just over a decade ago the Americans were losing one aeromedical helicopter every week. In recent years, the loss rate has decreased substantially. In 2008 there were nine fatal accidents which killed 35 people. The following year in 2009 nine fatal accidents killing another eleven.

These figures could be compared with say; Qantas, and the expectations of their fare paying public. If you compare the HEMS loss rate over a typical year with Qantas carrying 38 million passengers without a single loss of an aircrew member, then you can see why the United States regulators have been reconsidering HEMS operations.

To put it bluntly, recent HEMS experience shows one crew member was killed for every 20,000 patients carried. By comparison, if Qantas had the same loss rate then almost 2,000 Qantas aircrew would have died to achieve the same uplift capability – 38 million??

This latent problem is probably being overlooked by the emerging Chinese HEMS industry which is probably focused on the setting up of the manpower and logistic resources to commence an aeromedical system.

With the power of hindsight, international advisers will need to tell the leaders of the emerging industry within China, the road ahead has many potentially fatal potholes. (As happened last week). And the loss of three Thai helicopters in one week recently?

They will need to harness the knowledge and skills that have been developed by the Western nations in accident prevention techniques associated with the SAR and HEMS operations. There is no doubt past lessons were written in blood!

Western organisations must be ready to provide guidance to the new organisers of the emerging industry, now being established as the airspace is being progressively released. No doubt AAMS and other international agencies will also need to lend a hand to ensure the traditional risk management procedures are covered in their safety system management protocols.

The international safety agencies will probably have to push very hard to get their point of view across to a group of people who have never experienced the pain of operating an aeromedical industry without the appropriate checks and balances. Today, the US is still suffering losses which must be measured against “risk verses gain” and is there an alternative to a high risk flight?

What are your thoughts??

thoughts?

good to see you back Rob.

tet

I've read many of these reports. The reasons for "press-on-itis" need to be addressed. It's an organisational issue in some cases.

I've been in one SAR/Medevac/Casevac job where the department's measure of competence was the time of response. Totally dangerous. I took my time when needed and tried to impress upon those pilots less experienced than myself that they should do the same. I left the department. Not long afterwards one crew took a shortcut over a mountain at night after coming under pressure about a previous response time. They suffered a fatal CFIT accident.

Three lives and a valuable machine gambled against one life. They lost.

Trying to compare HEMS operations with Qantas is simply silly. Qantas carries hundreds of passengers per flight, HEMS almost always one. Qantas operates airliners to and from major airports, HEMS from unprepared scenes at night, and to and from hospital helipads which are some of the poorest in the country. They're almost always an afterthought, with obstacles all around. But disregard everything except the first point, and you still can't make a comparison, because of the sheer volume of passengers that Qantas and the other airlines move on each flight.

I've said it before, and I'll say it again. European and other pundits have no business pontificating on the state of the US industry, just as the US pundits should, and generally do, keep quiet about their industry. It's a different culture, under different rules, with different philosophies, expectations, and goals. Right or wrong, profit is the driving force for all business in the US, and that will not change no matter how much fun the rest of the world wants to make of it. Short-term profit is the end-all and be-all of the US economy, and short-term profit is not possible if multi-engine, multi-crew aircraft flown only under IFR are required. So get over it, those will never be required, and will seldom be used.

Our friends and colleagues on the eastern side of the salt water divide do not have the basis to pass judgement on our system especially if they try to compare theirs to ours. It is Apples and Oranges pure and simple.

If they wish to stick to discussions about individual factors and not a general broad brush comparison then we can in fact have a very good exploration into why EMS accidents occur, continue to occur, and continue to occur for the same reasons.

We have to consider the changes put in place within the past few years that have helped reduce the rate of accidents and the numbers of people killed.

Things are a bit different than the last time we had a really good bashing of ideas.....as I was the instigator of two threads about helicopter accidents and industry culpability in the EMS and Offshore sectors of the US Helicopter Industry.

Perhaps it is a time to reference those threads and update them by evaluating the systemic changes, changes in the ownership of the various operators, and the effect (good or bad) of regulation changes and enforcement activity by the FAA and within the Industry itself.

Our friends around the World have valuable experience and thus can inject some fresh thinking into our large oyster....their ideas might not be useful considering the politics and economy but they are definitely worth hearing and discussing.

Things are better here than they were....but are they as good as they should and can be.....that is definitely going to be good fun arguing!

Let's start with some up to date statistics....if we can find them and compare years 2010 and 2011 to previous years. Perhaps something will jump out at us that will indicate what the trends are as to accident rates, fatalities, injuries, and frequency....perhaps comparison of current causes compared to past data.

This profit driven philosophy is quite possibly where the much of the press-on-itis comes from. As for a mantra that the USA always knows best and no-one else is entitled to comment on any of it because they don't understand.....really!

How would relatives of a deceased patient or crew member feel if they knew that lives of their loved ones might not have been lost if things had been different i.e. profit for the service provider wasn't such a major issue?

We had a similar issue in UK a couple of decades ago. The only logical remedy was for CAA legislation to be tightened up, and it was.

As the saying goes, if you think safety is expensive, try having an accident.

No one has suggested that Shy....but I do believe the converse/reverse was strongly suggested as being just as wrong.

I see a lot of US HEMS bashing from around the world. Does anyone have easy access to the following:

US HEMS accident rate- fatal and non-fatal per 100,000 hours? Or 100,00 patient transports.
UK HEMS accident rate- "
Canadian HEMS accident rate- "
German HEMS accident rate- "
Australian HEMS accident rate- "

Commercial helicopter accident rates for the same countries per 100,000 hours.

Private helicopter accident rates for the same countries per 100,000 hours.


Number of HEMS machines on duty in each of the same countries and availability ie day, night and weather conditions.

This information would make interesting charts. I imagine it is coallated somewhere and someone here probably has easy access.

I like to tell the pilots I train that there were sick and injured people long before there was helicopters. The patient has to be stable before we even load them. A broken helicopter and/or crew will do that patient no good. "Above all, do no harm".

SAS, So I've completely missed the point of the second paragraph of post #67? OK.... :oh:

Seemed plain enough to me.

Limited Performance Margins
 

I can’t speak to European HEMES operations but I can address what I believe may be a contributing factor to the mishap rate here in the United States. The vast majority of US HEMS operations are would fall into a category identified as a traditional model. These are typically single engine machines strategically located to provide the operator with a solid business base for the machine. The AS-350 series make up a significant portion of this fleet. The AS-350 has limited payload range when kitted out for HEMS operations. It is typical to operate very near or at the aircraft’s maximum gross weight on every mission. A 250-300 lb patient in the US is the norm today in the US. At 33% fuel burn and using 11% (20 min.) with three 180 lb crewmen the fuel load would have to be limited to 45%. This leaves the pilot with only 1 hour mission fuel. Flexibility is not the norm.

Weight (Lbs) Arm (inches) Moment (inch-Lbs)
Total Empty Weight 3383.0 136.9 463132.7
* EMS Equip. 136 190.0 38787
Pilot Equip. 40 44.2 1745.9
Aircraft Basic Weight 3558 141.6 503665.6
Pilot 180 61.0 10980
Med 1 (fwd) 180 100.0 18000
Med 2 (aft) 180 100.0 18000
Mission Ready Weight 4098 134.4 550645.6
0
Patient 250 95.0 23750
Fuel (%) 45
Fuel (gal.) 146 Max. 66 0
Fuel 440 136.8 60217.992

Weight CG Moment
Takeoff Weight 4899 129.5 634613.592
* EMS Equip. includes items listed below in green
Available Payload 51 (lbs.) HOGE Wt.
23.23 (kgs.) 4950
Baggage Comp. EMS Equipment
Para Pack (9 lbs) 10
Backboard (14.5 lbs) 0
RSI Kit (16 lbs) 16
Tri Blue Bag (11 lbs) 11
Mast Pants (10 lbs) 10
KED Kit (9.5 lbs) 9.5
Green Bag (6 lbs) 6
Vent (2 lbs) 3.5
Traction Splint (5 lbs) 5
Misc. Equip. (3 lbs) 4.5
Total 75.5

By contrast the hospital based programs operate light and medium twin engine machines that provide sufficient payload range allowing for much greater flexibility and performance margins. I hope the Wt & Bal transfer to the PPRUNE format. It does not appear as if the excel spread sheet and chart translated very well. If anyone would like a copy just send me an email.

With the greatest respect to our American brothers, there is the problem, right there.

What is the acceptable death rate of pilots, medical personnel and patients before something has to be done to change this?

Huge differences between the US and UK for night operations....for all intents and purposes....there are none in the UK.

Now the response will be...."OH Yeah!" and they will quickly point out the Plod (Police or Po-leece) do them all the time. Private Operators....of which there are literally a hand full in the whole place....do not operate after dark (unless I am grossly mistaken).

Canada has a very enviable safety record....thus we might look to the North for some ideas.

The UK EMS folks are just as dedicated as their mates around the Globe...but the CAA/JAA/EASA or whatever authority that is in control at any given day...severely limits Night and IFR operations to the extent if you get injured at night in the UK you will in all liklihood be transported by ground.

A question has been posed....."What is an acceptable Loss rate in lives and aircraft?"

I turn it around...."What is the acceptable loss rate in patient lives that are lost due to the absence of a 24 hour HEMES operation?"

Huge differences in other aspects beside night operations.

How are scene responses handles if they are allowed at all?
Are all flights inter-facility?
Some countries do not allown VFR night operations. Some countries do not even allow civil night operations at all.

I watched a response in Wyoming several years ago. The helicopter and the ambulance both departed at the same time. I asked about this and the guy told me that since the distances are so far, and weather reporting so scarce, that the helicopter launches and if he can not make it to the scene (possibly 75 or 100 miles away) the ambulance is already enroute. If the helicopter makes the patient pick-up, the ambulance turns around and goes home. This is one scenario you won't have in Europe.

Canadians might have some very long legs, what is the Canadian scene response like? Do Canadians do scene responses or are they mainly inter-facility? Remember, Canadian health care is socailized. Non-profit and they surely do not launch for cases that are not worthy of helicopter transport.

You are grossly mistaken. The night flying season is almost here again.

ShyTorque:Apparently. Nothing in what Gomer said in Post #65 implied that the U.S. model is the best. It's just what it is (profit-driven), and nothing, not all the whining from people in any other country is going to change that. As a culture and a country, the U.S. is apparently okay with the loss rates compared with injured people saved. Oh, the NTSB will harumph and recommend after every accident, but in the end very little will change.

The acceptable accident and death rate will always vary between countries and cultures. It's a philosophical issue, and I'm not sure there is a right or wrong answer to that. Zero accidents by HEMS crews is one ideal, and a few accidents but fewer patient deaths because of lack of transport is another. It's a continuum without a firm boundary, like all moral issues. Should we let one person die to save many others, or save those we can and take a chance on many more deaths? Each person will have his own opinion, but I don't think any of them are necessarily right for everyone or everywhere. The US philosophy is the US philosophy, and the British philosophy is the British philosophy. Both are valid, but only for that locality.

To put it another, ruder, way, opinions are like a$$holes. Everyone has one, but the stink is in the nose of the beholder.

Another opinion I have is that you can't cure stupid. The profit motive has relatively little to do with press-on-itis, IMO, and the pressures are mostly self-imposed. My company has very strict weather minimums, and goes out of its way to remove pressure to fly. No one in the company has the authority to question the PIC's decision to fly or not, at any level. It's the pilot who decides to keep going in deteriorating weather, not the company's, and I believe that is the case in almost all the HEMS companies in the US. The hero mentality is dangerous, and I try to dampen it any time I see it. Anyone who is in this business to save lives is in grave danger of killing himself and his crew, but there are those who see the job that way. I don't know of a way to stop it, because you just can't cure stupid. Ignorance yes, but stupid, no.

FH1100, Exactly, so I understood the post perfectly. SAS was mistaken, not I.

If profit and company competition is put before flight safety then accidents will happen. Simple enough. Like it or not, your system is some years behind Europe, we aren't whining about it. After a series of high profile nightflying accidents in UK the CAA put in place further legislation in an attempt to reduce them.

E.g. No single engined public transport at night. Police and EMS/AA deemed public transport. Unstabilised police aircraft legislated out of existence. All police base helipads to be lit to an acceptable standard by night etc.

None of it will prevent a crew having an accident if they really try hard though.

Shy,

What I was thinking....but failed to get to my fingers....was HEMS Operators not "Private Operators".

Quote from GomerP:
"I've said it before, and I'll say it again. European and other pundits have no business pontificating on the state of the US industry, just as the US pundits should, and generally do, keep quiet about their industry. It's a different culture, under different rules, with different philosophies, expectations, and goals. Right or wrong, profit is the driving force for all business in the US, and that will not change no matter how much fun the rest of the world wants to make of it. Short-term profit is the end-all and be-all of the US economy, and short-term profit is not possible if multi-engine, multi-crew aircraft flown only under IFR are required. So get over it, those will never be required, and will seldom be used."

In more simple terms: You cannot fix stupid.

So, in accordance with that statement we should just let it be and let PATIENTS suffer the consequences, attitudes like that are the reason why I am happy to no longer operate in that segment of the industry.